Also called emotionally unstable personality disorder, emotional intensity disorder, or borderline type in the ICD-10, is a cluster-B personality disorder, the essential feature of which is a pattern of marked impulsivity and instability of affects, interpersonal relationships and self image. The pattern is present by early adulthood and occurs across a variety of situations and contexts. Symptoms usually include intense fears of abandonment and intense anger and irritability, the reason for which others have difficulty understanding. People with BPD often engage in idealization and devaluation of others, alternating between high positive regard and great disappointment. Self-harm and suicidal behavior are common.

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"Both individual and group psychotherapy have proven to be at least partially effective for many people with the disorder."

The experience of BPD can be distressing, not only for the person with the disorder, but for the people around them. Persons with BPD have a difficult time controlling their emotions and many times are in a state of upheaval. Childhood experiences or a brain dysfunction are potential reasons why.

Defining Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a form of mental illness that is characterized by a pervasive instability in moods, self-image, behavior, and interpersonal relationships. The instability the person experiences many times disrupts their work and family life, their sense of self-identity, and long-term planning. BPD was originally thought to be at the, 'borderline,' of psychosis; persons with BPD experience a disorder of emotional regulation. The disorder is not as well known as bipolar disorder or schizophrenia, however it is more common. BPD affects approximately two-percent of adults - young women, for the most part. Among the people affected there is a high rate of self-injury without suicidal intention, as well as a significant rate of attempted suicide and suicide in more severe cases. BPD accounts for around twenty-percent of the number of hospitalizations due to psychiatric reasons, although with assistance many people improve over a period of time and are able to lead productive lives.

The experience of BPD can be distressing, not only for the person with the disorder, but for the people around them. Persons with BPD have a difficult time controlling their emotions and many times are in a state of upheaval. Childhood experiences or a brain dysfunction are potential reasons why. Persons with BPD may have an image of themselves that is distorted, making them feel somehow fundamentally flawed or worthless. They can experience impulsivity, anger, frequent mood swings, and may push others away despite a desire for loving relationships.

Symptoms of Borderline Personality Disorder

Persons with borderline personality disorder may experience intense depression, anger or anxiety that lasts from several hours to a day. The feelings can be associated with episodes of self-injury, aggression, or alcohol or drug abuse. Distortions on the part of the person related to their sense of self or cognition may lead to frequent changes in their career plans, jobs, long-term goals, values or gender identity. The person may feel mistreated, unfairly misunderstood, empty, bored, or have little concept of who they are as a person. The symptoms the person experiences are most acute then they feel isolated or that they lack social support, which may result in frantic efforts to avoid being alone.

When it comes to social relationships, people with BPD often have unstable patterns related to them.

They may develop attachments that are intense, yet stormy; their attitudes towards friends, loved ones, and family members can quickly shift from admiration and love to dislike and even anger. The person might create an immediate attachment and idealize another person, yet when even a slight separation or conflict happens - they suddenly and unexpectedly switch to the opposite extreme, angrily accusing the other person of not caring for them. Even in relationships with family members, persons with BPD are extremely sensitive to rejection, many times reacting angrily and out of distress to even minor separations such as a business trip or a vacation, or a change in plans. Fears of abandonment may be related to difficulties in feeling connected emotionally to important persons when the person is absent, leaving the individual with BPD feeling lost.

Persons with BPD may present additional impulsive behaviors such as binge eating, risky sexual practices, or excessive spending. Many times, BPD co-occurs with other forms of psychiatric problems such as depression, bipolar disorder, substance abuse, other forms of personality disorders, or anxiety disorders. Borderline personality disorder affects the way a person feels about themselves, how they behave, as well as how they interact with others.

Causes of Borderline Personality Disorder

The causes of borderline personality disorder are complex. The name of the disorder came about due to theories in the 1940's and '50's which suggested that the disorder was itself on the, 'border,' between psychosis and neurosis. The views presented by these theories does not concur with modern thinking about the disorder. There are advocacy groups that have called for a change in designation for it, referring to it as, 'Emotional Regulation Disorder.'

In the meantime, the causes of borderline personality disorder remain under investigation. At this time there is no known way of preventing the disorder, although potential causes of it may include:

Genetics: Studies of twins and families suggest that personality disorders may be inherited.

Environmental Factors: A number of people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.

Brain Abnormalities: Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.

In all likelihood, a combination of these issues results in borderline personality disorder.

Risk Factors for Borderline Personality Disorder

One of the things that is known about BPD is that it forms during childhood. The disorder is shaped by environmental and inherited factors, as well as the person's experiences during childhood. There are some factors that are related to the development of personality which may increase a person's risk of developing borderline personality disorder; these may include:

Hereditary predisposition: A person may be at a higher risk if a close family member; a mother, father or sibling - has the disorder.

Childhood abuse: Many people with the disorder have reported being sexually or physically abused during childhood.

Neglect: Some people with the disorder described severe deprivation, neglect and abandonment during childhood.

Complications of Borderline Personality Disorder

Borderline personality disorder has the potential to damage a number of areas of a person's life. These areas of life may include the person's job, education, social activities, relationships, and self image. The person may experience repeated loss of jobs, or broken marriages. They may injure themselves by burning or cutting themselves, resulting in hospitalization and scarring. The suicide rate among persons with BPD is between ten and fifteen-percent. Persons with BPD are often involved in behaviors that are both impulsive and risky, making them more vulnerable to sexually transmitted diseases, unplanned pregnancies, car accidents, or physical confrontations. They may be involved in abusive relationships; either as the abused or the abuser.

Diagnosing Borderline Personality Disorder

A diagnosis regarding a personality disorder is based upon both signs and symptoms that are determined through a psychological evaluation. Persons who are diagnosed with BPD have met criteria that are found in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The manual is published and updated by the American Psychiatric Association and is used by mental health professionals to diagnose mental health conditions. In order to reach a diagnosis of BPD, a person must present with at least five of the following signs and symptoms:

Intense fears of abandonment

A pattern of unstable relationships

Unstable self-image

Impulsive and self-destructive behaviors

Suicidal behavior or self-injury

Wide mood swings

Chronic feelings of emptiness

Inappropriate anger

Periods of paranoia and loss of contact with reality

A diagnosis of BPD is usually made in adulthood, not while the person is either a child or an adolescent. The reason for this is because what may appear to be signs and symptoms of BPD can disappear as the person matures.

Treatment of Borderline Personality Disorder

Treatment of BPD has improved in recent years. Both individual and group psychotherapy have proven to be at least partially effective for many people with the disorder. In the last fifteen years, a new form of treatment referred to as, 'Dialectical Behavior Therapy (DBT),' has been developed specifically for the treatment of borderline personality disorder; it is a technique that appears to be promising in studies. Medication treatment is many times prescribed based upon the specific symptoms the person presents. Mood stabilizers and antidepressants can assist. Anti-psychotic medications may be administered if the person with BPD experiences distortions in thought.

Psychotherapy is the main form of treatment for BPD; there are two main forms of psychotherapy treatments in relation to the disorder:

Dialectical behavior therapy (DBT): DBT was designed specifically to treat the disorder. Generally conducted through individual, group and phone counseling, DBT uses a skills-based approach to teach you how to regulate your emotions, tolerate distress and improve relationships.

Transference-focused psychotherapy (TFP): TFP centers on the relationship between you and your therapist - helping you understand the emotions and difficulties inevitably arising in the relationship. You can then use what you have learned in other relationships.